Navigating Treatment Decisions with IgA Nephropathy

IgA nephropathy is a type of kidney disease that causes damage over time. This damage can lead to chronic kidney disease (CKD) or kidney failure. It can also lead to other issues like high blood pressure, high cholesterol, heart disease, and more.¹

There is no cure for IgA nephropathy. But starting and staying on treatment might help slow the progression of the condition in some people. Treatment can reduce the risk of developing more severe kidney issues. However, navigating treatment can be confusing and may require multiple drugs and lifestyle changes.^1-3

Choosing the right treatment for you

Each person’s experience with treatment will be different. Some people may have to go through a trial-and-error period to find what works best. Some common things you and your doctor will consider when creating a treatment plan include:⁴

• How well your kidneys are working (based on tests like your glomerular filtration rate, or GFR)
• How high your blood pressure is
• How much protein is in your urine
• Other health issues you have or drugs you take
• Other drugs you have tried for IgA nephropathy
• Your treatment goals
• The results of your kidney biopsy

Drugs used to treat IgA nephropathy

There are a few different drugs that doctors prescribe to treat IgA nephropathy. Each has its own effect on slowing progression or preventing related health problems (complications).^1,2,4

Drugs to lower blood pressure

High blood pressure can damage the kidneys. Damage from the kidneys can also raise blood pressure and cause other heart or blood vessel-related issues. Blood pressure drugs are used to slow down this cycle of damage.^1,2,4

Common types of blood pressure drugs are angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These drugs decrease the release of protein into the urine.^2,4

Another drug called spironolactone is commonly used to lower blood pressure. It works by releasing both water and sodium into the urine. Studies have shown that spironolactone may also lower the amount of protein spilled into the urine.^4,5

Drugs to reduce swelling

Protein plays a role in water balance within the body. When protein spills out in the urine because of IgA nephropathy, water levels become unbalanced. This leads to swelling and puffiness, especially of the hands, feet, ankles, and face. Diuretics are a type of drug used to help reduce swelling and better balance fluids.^1,2,4

Drugs to lower cholesterol

In people with IgA nephropathy, cholesterol can build up in the body. This can affect blood vessel walls and lead to several complications. Statins are a type of drug often used to keep cholesterol levels as low as possible.^1,2,4

Drugs that slow down the immune system

In IgA nephropathy, damage to the kidneys occurs due to inflammation. Turning down the immune system with drugs called immunosuppressants can help slow this process. Drugs like steroids are an example. There are also newer drugs currently being studied that may help with turning the immune system down.^1,2,4

This is not a complete list of all drugs used to treat IgA nephropathy. Drugs called SGLT2 inhibitors are sometimes used to help protect the kidneys as well. There are also newer drugs that aim to reduce protein in the urine. An example of this is the drug sparsentan. Finally, some doctors might recommend taking a fish oil supplement. This may help reduce inflammation or provide important fats the body is missing.^2,4

Keep in mind that all drugs have side effects. If you have IgA nephropathy, talk to your doctor about what to expect from the different drug treatment options.

Helpful lifestyle changes for IgA nephropathy

In addition to drugs, there are lifestyle changes that can help manage IgA nephropathy. These will vary person to person. But some common changes your doctor might recommend are:^1,4

• Eating a diet low in salt, saturated fat, and protein
• Eating more plant-based foods
• Reducing alcohol intake
• Quitting smoking
• Exercising regularly
• Sleeping well
• Managing stress as much as possible
• Safely reducing fluid intake to help with swelling

Your doctor can help guide you through making a plan for these lifestyle changes. They may also recommend that you meet with a dietitian or physical therapist to help create the right plan for you.

Treating chronic kidney disease and kidney failure

It is possible for other health issues to arise over time with IgA nephropathy. Most of these are a result of worsening kidney function or CKD. Examples include low red blood cell counts (anemia) or problems with bone strength. Certain drugs or vitamin supplements may be added to your treatment plan if these issues come up.⁴

When kidney damage progresses far enough, it can cause kidney failure. This is when one or both of the kidneys cannot perform their job at all. When a person enters kidney failure, they may need to start dialysis treatment. People on dialysis use a machine to help clean their blood. The dialysis machine does the job of the kidneys.^1,6

In some cases, a person may need a kidney transplant. In a kidney transplant, a working kidney from someone else (a donor) is put into the body during a surgery. This kidney can help perform some of the functions that the damaged kidneys cannot.^1,6

Before beginning treatment for IgA nephropathy, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.